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reminder-contact-your-member-of-congress-to-stop-year-end-medicare-cutsReminder: Contact Your Member of Congress to Stop Year-End Medicare CutsLatest_NewsShared_Content/News/Membership_Memo/2023/november-22/reminder-contact-your-member-of-congress-to-stop-year-end-medicare-cuts<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/november/medicare-graphic-645x425px.png" class="pull-right" alt="Support Medicare Sustainability graphic" /></div> <h5>November 22, 2023</h5> <h2>Reminder: Contact Your Member of Congress to Stop Year-End Medicare Cuts</h2> <p>With the Centers for Medicare and Medicaid Services proposing a 3.4% reduction in Medicare's physician payments for 2024, the WSMA is urging all members to contact their congressional representatives today and call on them to stop the cuts. There's less than two months left in the year, so please make this a priority. Everyone agrees the Medicare physician payment system is broken, and it's time for Congress to do something about it. <a href="https://physiciansgrassrootsnetwork.org/be-heard?vvsrc=%2fCampaigns%2f108965%2fRespond">Please contact your representative and senators and urge them to cancel the cuts.</a></p> <p>The WSMA is also urging Washington's congressional delegation to sign on to H.R. 2474, the Strengthening Medicare for Patients and Providers Act. The legislation applies a much-needed permanent inflation-based update to the Medicare Physician Fee Schedule conversion factor. <a href="[@]Shared_Content/News/Membership_Memo/2023/november-8/contact-your-member-of-congress-today-to-stop-year-end-medicare-cuts">Learn more about how you can help our advocacy on this long-term Medicare payment reform</a>.</p> </div>11/22/2023 12:00:00 AM1/1/0001 12:00:00 AM
deadline-approaching-for-comments-on-naturopath-scope-expansion-effortDeadline Approaching for Comments on Naturopath Scope Expansion EffortLatest_NewsShared_Content/News/Membership_Memo/2023/november-8/deadline-approaching-for-comments-on-naturopath-scope-expansion-effort<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/november/mortar-pestle-645x425px.jpg" class="pull-right" alt="mortar and pestle" /></div> <h5>November 8, 2023</h5> <!-- **************************NEW ARTICLE****************************** --> <h2>Deadline Approaching for Comments on Naturopath Scope Expansion Effort</h2> <p>The naturopathic profession in Washington state is continuing its effort to <a href="https://wsma.org/wsma/advocacy/legislative_regulatory/regulatory-priorities.aspx">expand naturopaths' scope of practice through legislation and rulemaking</a> without stipulating specific additional education requirements or training. At each juncture, the WSMA has opposed these efforts on the grounds that a naturopath's education and training do not include the comprehensive medical and pharmacological background needed to safely prescribe controlled substances and perform additional procedures as proposed. We strongly encourage physicians in all specialties to provide feedback on the proposal ahead of the Nov. 20 deadline.</p> <p>In the latest chapter of this years-long effort, the Washington State Department of Health will be conducting a sunrise review of the naturopathic scope of practice as <a href="https://doh.wa.gov/sites/default/files/2023-10/NaturopathySunriseAppReport2023.pdf?uid=65208b53a2046">requested by the Washington Association of Naturopathic Physicians</a>. The DOH will review <a href="https://app.leg.wa.gov/billsummary?BillNumber=5411&Year=2023&Initiative=false">Senate Bill 5411</a> from the 2023 legislative session. As a reminder, SB 5411 makes several updates to the naturopathic practice act including:</p> <ul> <li>Expanding prescriptive authority to include controlled substances schedules II-V. This change would include opioids. Naturopaths currently have a very narrow prescriptive authority that is limited to legend drugs, codeine, testosterone, hormones, and other substances consistent with the practice of naturopathic medicine.</li> <li>Allowing a naturopath to sign and attest to any certification cards, forms, or required documents that a physician can sign.</li> <li>Changing the definition of "minor office procedure" to include primary care services and treatment of minor injuries. This "minor office procedure" has been interpreted by the naturopathic association to include things like in-office abortions.</li> </ul> <p><strong>The WSMA strongly believes that this proposal is a threat to the entire physician community</strong>. Most recently, the naturopathic community has expressed interest in the scopes of practice for obstetrics and gynecology, urology, ophthalmology, dermatology, plastic surgery, and anesthesiology. The applicant report expresses interest in treating behavioral/mental health conditions, performing in-office abortions, and treating opioid use disorder, among other things.</p> <h3>All specialties urged to provide feedback on proposal</h3> <p>As part of its sunrise review and to help DOH make informed recommendations to the Legislature on this proposal, the department is accepting public comments at <a href="mailto:sunrise@doh.wa.gov">sunrise@doh.wa.gov</a> through 5 p.m. on Nov. 20, 2023. Given the naturopaths' wide-ranging interest in scope expansion, WSMA staff have routed a call to action to our specialty society partners urging opposition to this proposal. WSMA's policy team is in the process of reviewing the application, and we will share our draft comment as a model for WSMA members from all specialties to work from.</p> <p>The proposal under review consists of the following documents DOH received from the Legislature and applicant group:</p> <ul> <li><a href="https://doh.wa.gov/sites/default/files/2023-10/NaturopathySunriseRequest2023.pdf?uid=65208b53a13ea">Letter from Senate Health and Long Term Care Committee</a></li> <li><a href="https://doh.wa.gov/sites/default/files/2023-10/SenateBill5411-NP.pdf?uid=65208b53a1ad1">Senate Bill 5411</a></li> <li><a href="https://doh.wa.gov/sites/default/files/2023-10/NaturopathySunriseAppReport2023.pdf?uid=65208b53a2046">Applicant report submitted by WANP</a></li> </ul> <p>Learn more about the <a href="https://doh.wa.gov/about-us/programs-and-services/executive-office-prevention-safety-and-health/health-systems-quality-assurance/sunrise-reviews">DOH sunrise review process</a>.</p> </div>11/8/2023 12:00:00 AM1/1/0001 12:00:00 AM
its-time-for-action-on-unsustainable-medicaid-paymentsIt's Time for Action on Unsustainable Medicaid PaymentsLatest_NewsShared_Content/News/Membership_Memo/2023/november-8/its-time-for-action-on-unsustainable-medicaid-payments<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/november/shutterstock-2033522243-645x425px.jpg" class="pull-right" alt="Male doctor and patient" /></div> <h5>November 8, 2023</h5> <h2>It's Time for Action on Unsustainable Medicaid Payments</h2> <p>This week, the WSMA sent an action alert to Washington's physician community encouraging physicians, clinics, and medical groups to share stories with their legislators of how low Medicaid reimbursements, particularly for specialty care, impact their practices and patient access to care. If you haven't yet shared your perspective, <a href="https://takeaction.wsma.org/">do so today</a>.</p> <p>The WSMA is working on a solution that will help draw down federal dollars and increase Medicaid rates across the board for the physician community. We will have more information on our proposal in the weeks ahead. The WSMA will be engaging stakeholders from across the health care spectrum-specialty societies, medical groups, county medical societies, clinics, systems, and more-to mobilize on this issue in anticipation of the state legislative session that begins in January. The state is long overdue in making needed investments to ensure that Medicaid patients have access to not only health coverage, but also health care. This can't wait.</p> <h3>How you can help with our Medicaid effort</h3> <p>While WSMA staff will be working hard to advocate on your behalf with legislators and in the media, there is no substitute for the expertise and perspective of those physicians, practices, and clinics witnessing "on the ground" how low Medicaid reimbursements are impacting their ability to provide care to their patients. Your experiences and knowledge of your community can be invaluable to local legislators and media-and may change minds.</p> <p>If you'd like to help with this effort, visit our <a href="https://takeaction.wsma.org/get-engaged/">campaign page to volunteer</a>. WSMA staff will be in touch with more information about how you can help.</p> </div>11/8/2023 12:00:00 AM1/1/0001 12:00:00 AM
preventing-the-great-resignationPreventing the Great ResignationLatest_NewsShared_Content/News/Latest_News/2023/preventing-the-great-resignation<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/november-december/cover-wsma-reports-novdec-2023-645x425px.jpg" class="pull-right" alt="cover of November/December 2023 issue of WSMA Reports" /></div> <h5>November 7, 2023</h5> <h2>Preventing the Great Resignation</h2> <p> By Rita Colorito </p> <h5> <em>Members only; sign-in required.</em> </h5> <p> Soon after Garrett Jeffery, DO, took over as section chief of two of PeaceHealth's Bellingham family medicine clinics in early 2020, the COVID-19 pandemic would push his health care workforce to the breaking point. "We just saw a lot of resignations over the course of those three years. Some left for different jobs. Some left health care entirely. And it just didn't seem to let up," says Dr. Jeffery. </p> <p> Even before the pandemic, burnout plagued medicine. In 2018, the National Academy of Medicine proclaimed it an epidemic. In May 2022, U.S. Surgeon General Dr. Vivek Murthy issued an advisory highlighting the urgent need to address the health worker burnout crisis across the country, pointing to the record numbers of health workers who are quitting or reporting that they intend to quit. </p> <p> Since that advisory, the American Medical Association, the Medical Group Management Association, the Commonwealth Fund, and KFF Health News, among others, have reported more recent data on burnout prompting physicians and clinicians to leave the workforce. According to the Physicians Foundation's 2023 Survey of America's Current and Future Physicians, for the third year in a row, 60% of physicians report often having feelings of burnout. That's compared to 40% prior to the pandemic.</p> <p> Ensuring a strong physician workforce has always been a priority for the WSMA and other health care workforce advocacy organizations. While evidence doesn't yet show that a "great resignation" has taken place, the potential looms large if health care employers-systems, hospitals, large groups, and clinics-don't address burnout and its impact on retention, says Sue Skillman, senior deputy director of the Center for Health Workforce Studies at the University of Washington. </p> <h3>A shift to workforce retention</h3> <p> When it comes to building a strong health care workforce, retention has been underrecognized and undervalued for far too long, says Skillman. She also hesitates to use the term workforce shortage. "That implies that you can solve the problem by just producing more in the education system. And as many before me have said, we can't educate ourselves out of the workforce issues that we're dealing with," she says. "While education is important in keeping the supply growing, we have to incentivize those already in the field to want to work in the settings where we want them to work." </p> <p> Yet, unlike requesting more government funding for medical training, retention solutions don't come with an easy legislative ask, says Skillman. "But we need to start talking about these things. We need the collective will and creativity to do that." </p> <p> While the drivers of burnout are multifaceted, organized medicine is united in its belief that the conversation must move away from individual resilience to focus on systemic issues that drive burnout and on adopting best practices to ensure physicians and clinicians are supported appropriately. </p> <p> To bolster physician wellness, the WSMA and the WSMA Foundation have been awarded a grant from the Physicians Foundation for a physician wellness initiative that will look at systemic solutions to physician and physician assistant burnout, including getting health systems and large groups together to come up with best practices and to pledge their commitment to meet those best practices. </p> <p> In addition, the WSMA has convened a small work group with members from the Washington State Medical Group Management Association and Washington state's large group leaders to create a package of workforce policy solutions in advance of the 2024 legislative session. </p> <p> Failing to address worker burnout and the workforce retention crisis, says Dr. Jeffery, who participates in WSMA's workforce work group, will make it harder for patients to get care when they need it, cause health costs to rise, hinder our ability to prepare for the next public health emergency, and worsen health disparities. </p> <h3>Starting at the top</h3> <p> The Physicians Foundation report found that prioritizing physician well-being is critical to addressing burnout. Yet only 31% of physicians agree that their workplace culture prioritizes physician well-being, down from 36% a year ago. </p> <p> Tackling burnout means addressing mental health head on, says Mark Mantei, CEO of Vancouver Clinic and a member of WSMA's workforce work group. Vancouver Clinic provides employees with up to six visits with a licensed counselor free of charge and often accessible within two days. "It's sometimes very helpful to be able to talk to a neutral party about this before your burnout reaches a height where you're just not able to function," says Mantei. "Calling out that it exists and then offering some resources around it is a step all of us in the industry need to take. Nobody's beyond a need for that." </p> <p> At PeaceHealth, Dr. Jeffery has made physician well-being central to workforce recruitment and retention. Strong physician leadership, he says, is a component of broader workforce team retention. </p> <p> "The things that cause people to be engaged in their work, the three pillars, have been referred to as value, reimbursement, and growth. Do they feel heard? Are they being compensated well? And are they able to learn and grow?" says Dr. Jeffery. At PeaceHealth, he's created a culture change based on those three pillars from lessons he learned from one of his mentors, Dr. Trish Wooden, as well as during WSMA's Leadership Development Conference in 2021. </p> <p> "People really want to feel valued. To feel that their roles are fulfilling, that they're part of a team that makes a difference. And there's study after study that shows that," says Skillman. </p> <h3>Reducing documentation overload</h3> <p> Reducing barriers that prevent physicians and other clinicians from working at their highest licensure is critical to physicians feeling valued, reducing burnout, and increasing retention, says Mantei. </p> <p> Spending time on unpaid work, such as prior authorizations, are common frustrations expressed by physicians and clinicians in WSMA's workforce work group, says Dr. Jeffery. These frustrations are echoed in the Physicians Foundation report, which found that at least half of physicians reported documentation protocols, insurance requirements, regulatory policies, and mandatory training requirements were a hindrance to their autonomy and to their ability to deliver high-quality, cost- efficient care. </p> <p> And some 80% of survey respondents said they found reducing administrative burdens helpful to their overall well- being. So, it's no wonder many health care organizations have made reducing physician documentation overload central to their retention efforts. </p> <p> Vancouver Clinic has seen a moderate uptick in turnover, increasing since the end of the pandemic rather than during it, says Mantei. That's because the shutdown of nonessential patient care during the pandemic created backed up demand for patient care now. Other health care systems are seeing similar trends. </p> <p> "Primary care folk are experiencing a larger patient panel because of high demand and the workforce shortages in general. So, what we've seen is acuity go up, and then available primary care go down," says Mantei. Health care organizations also haven't put the necessary systems in place to manage the increased use of telehealth that was fast-tracked during the pandemic. </p> <p> A major stress point for physicians and health care professionals is what Mantei calls managing digital medicine-patient medical records and the clinician's inbox. "So many patients got used to corresponding via clinician inbox during the pandemic, and it's continued. It's a good thing. But we haven't adapted all of our systems to really cope with it very well." </p> <p> To help physicians get a handle on data entry, PeaceHealth has shifted the responsibility of updating medical history and other information to patients through their electronic medical record. "That's been a tremendous help with our workflow. Physicians are spending less time on data entry and more time seeing the patient," says Dr. Jeffery. "And patients are in more granular control, which we know improves the accuracy of the data entry. It's just a commonsense move." </p> <p> Physicians at PeaceHealth and Vancouver Clinic also have begun using medical AI scribes, a tool that automatically transforms conversations during patient medical exams into medical documentation. "Doctors are able to spend less time documenting and more time face to face with their patient," says Dr. Jeffery. "It's part of a global effort to try to decrease work at the computer and improve efficiencies in documenting." </p> <p> Providence, PeaceHealth, and Vancouver Clinic also rely on medical assistants, often through on-the-job apprenticeship programs, to alleviate the documentation burden on physicians. But apprenticeship alone cannot meet all MA demand, says Skillman, as MA positions have among the highest vacancies among health care occupations. </p> <h3>Providing a work-life balance</h3> <p> Dr. Jeffery says his first order of business in his clinics was advocating for culture change, including focusing on work-life balance, better internal communication, and reframing the workforce experience. "As we drove culture change, and really engaged with our workforce, we emerged from a period of staffing turnover to a place where now we're celebrating consistent staff retention. And we're onboarding new physicians now," says Dr. Jeffery. "We're really pleased with where we are today. But there's still more to do." </p> <p> During the pandemic, flexible work schedules and remote work options became critical to work-life balance, solutions that continue to play an important role in long-term workforce retention, says Amber Pedersen, RN, immediate past president of the Washington State Medical Group Management Association and member of WSMA's workforce work group. </p> <p> In her role as director of clinical service at Providence Medical Group in Spokane, Pedersen promotes flexible work schedules as a way for staff to achieve a work-life balance. "We look at each position and ask, 'What is its ability to be remote? Or could it be hybrid? Can they work four 10s? Can some of this work be done in the off hours?' We have dedicated resources looking at all of those issues in each position," she says. </p> <p> Moving to value-based care has also added to physician stress. To manage the related complexities, PeaceHealth broadly reevaluated the panel sizes and metrics for their physicians and advanced practitioners. "Using published methodology to examine panel sizes gave us a good way to look at where we were going as an organization and remove some of the variability across the organization. In many cases, it also gave us a practical way to calculate a number of patients assigned to each physician or clinician based on what they historically have been able to do," says Dr. Jeffery. </p> <p> Feedback on PeaceHealth's numerous retention initiatives has been positive. One supervisor highlighted that some staff are opting for career advancement from within the PeaceHealth system, rather than leaving the organization altogether. "That's a huge shift," says Dr. Jeffery. "This shows that because our focus is on work-life balance-and you can't find that everywhere-people are choosing to advance rather than quit." </p> <h3>Tackling external issues</h3> <p> Child care, elder care, and housing aren't typically things one thinks about when it comes to physician retention. But lack of access to these and their high costs are major barriers to work-life balance and critical drivers of physicians moving out of state, says Dr. Jeffery. </p> <p> These issues go beyond the scope of what health care organizations can solely control, says Skillman. "We can't solve them alone, but we can't ignore them." </p> <p> In his role as president of the Northwest Washington Medical Society, Dr. Jeffery has tried partnering with community organizations to increase available child care for health care workers only to be told there are not enough child care providers. "That's something that is big picture. It's not all in our control. But that's something that we need to also be talking with our legislatures about," he says. </p> <p> Some systemic organizational changes, such as flexible work schedules and telehealth, however, can indirectly address these larger societal issues, says Pedersen. "In one of my clinics, someone doing four 10s saved their household quite a bit of money. Because they don't need to drive that extra day, they save on gas. And so that was a retainer for this employee who worked a long distance from our facility," says Pedersen. </p> <h3>The cost of doing nothing</h3> <p> Failing to make changes that address burnout and workforce retention comes at a steep price. A study published in Mayo Clinic Proceedings estimated that primary care physician turnover, fueled partially by burnout, leads to nearly $1 billion in excess health care spending each year. </p> <p> Each physician turnover costs organizations anywhere from $500,000 to more than $1 million on average, according to AMA. "There's lost productivity as well as the cost of recruiting and signing on a new physician with decreased productivity, in comparison, in their first year," says Dr. Jeffery. </p> <p> Workforce gaps and inconsistent staffing also mean health care systems will struggle to embrace new technologies or more efficient delivery models, says Skillman. "It just slows you down and may prevent adoption of new innovations and things that are going to ultimately help the practice and hopefully help the health care outcomes you're trying to deliver." Skillman recently heard from one rural health clinic that couldn't implement several initiatives because a key staff person had left. </p> <p> Not putting effective systems in place will only lead to higher burnout and even more difficulty recruiting a skilled workforce, says Pedersen. "Your workforce isn't only looking for opportunities in the local area. With advances in technology, they are now looking globally. And so, if you're not on top of it and not meeting the needs or understanding the needs of your workforce, you won't have one." </p> <p> Thanks to PeaceHealth's systemic changes to address physician wellness and retention, its Bellingham location is now functioning at full capacity. "I have staff now that call us their second home," says Dr. Jeffery. "That goes back to the culture changes we fostered. We're now having to share our staff out with the other clinics because they haven't done the same work on culture. And they're continuing to see the physician exodus and turnover." </p> <h3>The work ahead</h3> <p> Systemic efforts at increasing retention fall short if policymakers aren't involved, says Skillman. "When we talk to legislators, the conversation typically moves to medical school loan repayment or putting more seats in medical schools. And those are easily identifiable solutions to workforce problems, especially when people use the word shortage a lot. But those are long-term solutions. If we could retain the skilled workforce longer in their work settings, it just seems like a much simpler solution," says Skillman. "Maybe I'm naïve. I'm not a clinician; I don't run a clinic or hospital. But I really would like to see more emphasis on those solutions for which we have a lot of evidence." </p> <p> Skillman encourages health care employers to make their voices heard on workforce issues through the Washington State Health Workforce Sentinel Network, a collaborative effort funded by the state Legislature to provide an objective filter of information to planners and policymakers. "Every six months, it's an open call for input. Anyone who identifies as a health care employer can respond," says Skillman. "It's a tool to take those voices, take input from health care employers and health care settings, and get those issues to the foreground. So, it's actionable." </p> <p> <em>Rita Colorito is a freelance writer specializing in health care.</em> </p> <p> <em>This article was featured in the November/December 2023 issue of WSMA Reports, WSMA's print magazine.</em> </p> </div>11/7/2023 12:00:00 AM1/1/0001 12:00:00 AM
member-profile-penny-reck-mdMember Profile: Penny Reck, MDLatest_NewsShared_Content/News/Latest_News/2023/member-profile-penny-reck-md<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/november-december/member-profile-website-image-reck-645x425px.png" class="pull-right" alt="Member Profile: Penny Reck, MD logo" /></div> <h5>November 6, 2023</h5> <h2>Member Profile: Penny Reck, MD</h2> <p> <strong>Works at:</strong> Clarus Eye Centre (The Retina Service) in Lacey. </p> <p> <strong>How long in practice:</strong> Since 2008. </p> <p> <strong>Specialty: </strong>Retina. </p> <p> <strong>Why WSMA:</strong> I joined for the opportunity to connect with other physicians and to have access to WSMA resources. The WSMA is active with health care policy and legislative advocacy with knowledgeable staff who support physicians all over the state, and they play a vital role in supporting physicians to be active and effective advocates. The WSMA's House of Delegates generates a positive vibe of mentorship combined with insightful and respectful collaboration, and inspires me to try to do more. </p> <p> <strong>Proud moment in medicine:</strong> My mom, a pediatrician for more than 30 years, was diagnosed with breast cancer in late 2015. Despite being married to a doctor, she asked me to help with overseeing her care, which was provided by a female plastic surgeon and a female surgical oncologist. Mom's successful 8-1/2-hour surgery (bilateral mastectomies with immediate reconstruction) took place under the deft surgical skills of these working mom surgeons on Feb. 3, 2016, which also just happened to be the first National Women Physicians Day. On that day-167 years after Elizabeth Blackwell, MD, became the first woman to earn a medical degree from an American medical school-lifesaving medical care was delivered to a female physician by female physicians. That moment gave me mindful pause to appreciate and celebrate the successful journey of women in medicine. </p> <p> <strong>Top concerns in medicine:</strong> Loss of quality and efficiency due to problems like reimbursement cuts despite rising costs of care delivery; growing financial disparity despite calls for equity and improved access; work-life balance, burnout, and a resulting lack of civic engagement. We need more representation and visible action to ensure we have a health care system created by the people who deliver that care.</p> <p> <strong>Spare time:</strong> Besides being a transportation service for my kids, I attend school district board meetings, provide public comment, and help keep families informed because I believe that high-quality public education is society's best chance to break down equity barriers. I also enjoy stealing a moment to play the piano, especially when the kids join in to sing or add other instruments or percussion. Some moments are just a little better with "more cowbell." </p> <p> <strong>What people might not know about me: </strong>I had 13 years of formal dance training and dreamed of dancing on Broadway or in Los Angeles for music videos. I choreographed student productions in college and medical school, and one of my life's passions still is to dance. </p> <p> <strong>Best advice: </strong>In a debrief when I was a competitive swimmer, my coach said: "At some point, you just need to let go, go for it, and push through. Even when it gets painful. Because it'll be okay. You're ready." It was ambiguous feedback, as post-swim critiques are typically specific and technical. But with that counsel, she captured the idea that preparedness, action, confidence, and perseverance are fundamental tools to achieve a goal. If you have all that, even when the challenge feels overwhelming, "hit go." </p> <p> <em>This article was featured in the November/December 2023 issue of WSMA Reports, WSMA's print magazine.</em> </p> </div>11/6/2023 12:00:00 AM1/1/0001 12:00:00 AM
passion-and-policymaking-at-2023-house-of-delegatesPassion and Policymaking at 2023 House of DelegatesLatest_NewsShared_Content/News/Latest_News/2023/passion-and-policymaking-at-2023-house-of-delegates<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/september/2023-annual-meeting-main-graphic-v2-645x425px.png" class="pull-right" alt="2023 WSMA Annual Meeting House of Delegates logo"></div> <h5>November 1, 2023</h5> <h2>Passion and Policymaking at 2023 House of Delegates</h2> <p> Nearly 200 delegates representing numerous specialty and county medical societies in Washington convened at The Westin Bellevue in late September for the 134th Annual Meeting of the WSMA House of Delegates. Holding the legislative power of the WSMA as defined in the association's bylaws, this select group of physicians, residents, medical students, and physician assistants were tasked with establishing policy and electing officers for the association-while having a bit of collegial fun in the process. </p> <p> Before the House got down to its official business, delegates and other interested WSMA members attending the meeting heard from outgoing WSMA President Katina Rue, DO, who kicked off Saturday's opening session with opening remarks and the presentation of the 2023 WSMA Apple Awards. Following Dr. Rue, Secretary of Health Umair Shah, MD, provided an overview of changes in Washington's public health infrastructure and outreach since he took office, and encouraged greater collaboration with physicians in the field. The House then paused for reference committee breakout meetings, where resolutions were discussed and debated in small-group settings. </p> <p> Up next: The WAMPAC Luncheon. A perennial favorite, this fundraising event for WSMA's nonpartisan political action committee featured the majority and minority leaders of the state House of Representatives, who talked policy and politics before taking questions from WSMA members. Keeping things lively, WSMA staff led a raffle for WAMPAC's Diamond Club contributors in attendance along with a game of trivia to test the political acumen of attendees. </p> <p> Saturday afternoon, as reference committee members got to work drafting their reports (learn more about this process on the <a href="[@]wsma/events/annual_meeting/annual_meeting.aspx#about">Annual Meeting webpage</a>), attendees reconvened for CME presentations covering critical topics in medicine. Stephen Bezruchka, MD, led an impassioned discussion on how physicians can tackle factors that have the greatest impact on population health-and why physicians should act and not despair when facing these daunting problems. Ed Walker, MD, senior physician advisor for the WSMA Center for Leadership Development, followed with a perspective on the importance of burnout recognition and treatment from a system-level view rather than a self-care, wellness model. Then the American Medical Association's immediate past chair of the board of trustees Sandra Adamson Fryhofer, MD, did a deep dive on the AMA's Recovery Plan for America's Physicians. </p> <p> Finally, attendees and staff gathered to inaugurate WSMA's 2023-2024 president, Mukilteo OB-GYN Nariman Heshmati, MD, celebrating the start of his tenure at a reception in his honor-and unwinding after a long day of House business. </p> <p> Sunday dawned with delegations meeting at their respective caucus breakfasts to review reference committee reports in anticipation of the morning's final House session. After the House convened, but before they got down to business, delegates heard a moving speech by WSMA's new president, Dr. Heshmati (read or watch his speech at wsma.org). </p> <p> Speakers Matthew Grierson, MD, and Ray Hsiao, MD, then deftly led delegates through debate and action on the business before the House. Up for consideration were nearly 40 resolutions, many of which tackled major topics being grappled with nationwide, including the role of AI in medicine, unionization, the opioid epidemic, and more. Ultimately, the policies adopted by the House on Sunday shared a collective emphasis from the house of medicine to keep medicine "physician driven and patient focused" in the face of major societal disruptions. </p> <h3>Official Actions of the 2023 House of Delegates</h3> <div class="row"> <div class="col-md-2"><img alt="" src="/images/Newsletters/latest-news/2023/oct/venticinque-230924-4025-large-for-web-round.png" class="pull-left" style="width: 125px;"></div> <div class="col-md-10"> <p> Policymaking is at the heart of the WSMA Annual Meeting, as the approximately 175 WSMA members who make up the House of Delegates, the WSMA's "physician legislature," gather to debate and determine policy for your state medical association. The policies passed during this year's House of Delegates reflect an urgency on behalf of Washington's physician community to reclaim the primacy of the patient-physician relationship and ensure physicians stay in the driver's seat of patient care. For a full account of the actions of the House, download the <a href="[@]wsma/about/who_we_are/house-of-delegates.aspx?hkey=c5e98d40-6e37-4bc0-9bda-a7aa66e67919&WebsiteKey=c182ff6d-1438-4899-abc5-614681b54927">Official Actions of the 2023 WSMA House of Delegates</a>. </p> </div> </div> <h3>Meet WSMA's new leadership</h3> <div class="row"> <div class="col-md-2"><img alt="" src="/images/Newsletters/latest-news/2023/oct/heshmati-nari-2021-round-125x125px.png" class="pull-left"></div> <div class="col-md-10"> <p> In addition to determining policy for the WSMA, the 2023 House of Delegates inaugurated a new president for the WSMA and elected new officers and board members. </p> <p> OB-GYN Nariman Heshmati, MD, FACOG, of Mukilteo was inaugurated as WSMA president for 2023-2024. Dr. Heshmati is the executive medical director of affordability, advocacy, and pharmacy for Optum Washington, which includes The Everett Clinic, The Polyclinic, and the Optum Care Network Pacific Northwest. Watch his inaugural address below. </p> </div> </div> <!-- !Video: ****************************************** --> <div style="padding: 56.25% 0 0 0; position: relative;"> <iframe src="https://player.vimeo.com/video/875691128?badge=0&autopause=0&quality_selector=1&progress_bar=1&player_id=0&app_id=58479" title="2023-24 WSMA President Dr. Nariman Heshmati's inaugural address Sunday, Sept. 24 2023 WSMA House of Delegates" style="position: absolute; top: 0; left: 0; width: 100%; height: 100%;" allow="autoplay; fullscreen" loading="lazy"></iframe> </div> <script src="https://player.vimeo.com/api/player.js"></script> <br> <p> Newly elected as officers at the meeting: John Bramhall, MD, PhD, Seattle anesthesiologist, president-elect; Bridget Bush, MD, FASA, Anacortes anesthesiologist, vice president; and Matt Hollon, MD, MPH, FACP, Spokane internist, secretary-treasurer. The fifth officer of WSMA's executive committee is Past President Katina Rue, DO, FAAFP, FACOFP, Yakima family physician, who will serve as committee chair. </p> <p> Newly elected to the association's board of trustees: Rajneet Lamba, MD, Kirkland internist; Amy Ellingson, MD, Brewster family physician; Lisa Ivanjack, MD, Bothell internist; John Scott, MD, Seattle gastroenterologist; Peter Barkett, MD, Silverdale internist; and Andy Shang, medical student, Pacific Northwest University of Health Sciences. </p> <p> Visit the for a full roster of WSMA board of trustees members and to learn more about the governing bodies of your state medical association. </p> <h3>2023 Apple Award winners</h3> <div class="row"> <div class="col-md-2"><img alt="" src="/images/Newsletters/latest-news/2023/oct/apple-awards-2021-round.png" class="pull-left" style="width: 125px;"></div> <div class="col-md-10"> <p> This year marked the fifth annual WSMA Apple Awards, so named for the common and locally appropriate symbol of good health. Winners of the 2023 awards: </p> <p> Seattle ophthalmologist Aaron Weingeist, MD, retired Olympia OB-GYN Annie Iriye, MD, and Redmond internist Teresa Girolami, MD, were each presented a Grassroots Advocate Award, recognizing advocacy efforts and activities that support WSMA legislative priorities. </p> </div> </div> <p> Optum Washington received the 2023 Wellness Award, recognizing an organization that has worked to put the joy back in medicine for Washington physicians, either by supporting a culture of wellness, efficiency of practice, or personal resilience. </p> <p> Wenatchee family physician Mabel Bodell, MD, received the 2023 William O. Robertson, MD, Patient Safety Award, named after WSMA past-president and patient-safety champion William O. Robertson, MD, recognizing innovative patient safety initiatives in the ambulatory care setting. </p> <p> Seattle medical leadership educator Ed Walker, MD, received the President's Unsung Hero Award, recognizing his extraordinary contributions and service to the profession and our community. </p> <p>Congratulations to our award winners!</p> <h3>Honoring our newest 50-Year Club members</h3> <div class="row"> <div class="col-md-2"><img alt="" src="/images/Newsletters/latest-news/2023/oct/50-year-club-graphic-round.png" class="pull-left" style="width: 125px;"></div> <div class="col-md-10"> <p> This year, 15 WSMA members were inducted into the WSMA 50-Year Club, which celebrates and honors members who have been practicing medicine for 50 years. They are: John Adkison, MD, of Yakima; William Butler, MD, of Seattle; Gerald Duris, MD, of Puyallup; Thomas Gillette, MD, of Seattle; William Hutton, MD, of Aberdeen; James Komorous, MD, of Clarkston; Gene Liaw, MD, of Bellevue; John Luber, MD, of Tacoma; Michael Luce, MD, of Dayton; Ronald Maier, MD, of Seattle; Kenneth Mayeda, MD, of Seattle; Leroy Nill, MD, of Edmonds; Benjamin Podemski, MD, of Seattle; Christopher Varley, MD, of Seattle; and Richard Veith, MD, of Seattle. </p> </div> </div> <h3>2024 Annual Meeting: Save the date!</h3> <div class="row"> <div class="col-md-2"><img alt="" src="/images/Newsletters/latest-news/2023/oct/davenport-exterior-round.png" class="pull-left" style="width: 125px;"></div> <div class="col-md-10"> <p> Mark your calendars now for next year's meeting, Sept. 28-29 at the Historic Davenport in Spokane. </p> </div> </div> </div>11/1/2023 12:00:00 AM1/1/0001 12:00:00 AM
new-episodes-of-better-prescribing-better-treatment-cme-podcastNew Episodes of Better Prescribing, Better Treatment CME PodcastLatest_NewsShared_Content/News/Membership_Memo/2023/october-27/new-episodes-of-better-prescribing-better-treatment-cme-podcast<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/september/wsma-bpbt-podcast-logo-645x425px.png" class="pull-right" alt="Better Prescribing, Better Treatment logo" /></div> <h5>October 27, 2023</h5> <h2>New Episodes of Better Prescribing, Better Treatment CME Podcast </h2> <p><em>Now available via Apple, Google, and Spotify</em> </p> <p>We hope you've enjoyed the first eight episodes of WSMA's new Better Prescribing, Better Treatment Podcast; episodes 9 and 10, hosted by Nathan Schlicher, MD, JD, are now available. In these new episodes, Dr. Schlicher speaks with Liz Wolkin, MS, RN, about the Washington State Health Care Authority's new bridge program, and Rae Wright, MD, an addiction medicine physician in Vancouver, Washington on how opioid use disorder interfaces with equity issues.</p> <h3>About the podcast </h3> <p>Through the course of this 18-episode series, host Nathan Schlicher, MD, JD, talks with experts on an array of topics addressing the gaps in practice that exist between the current state of prescribing and the best practices surrounding opioid and controlled substance prescriptions. A sole production of the WSMA and offering continuing education credit for physicians and physician assistants, the podcast is available at no cost to all physicians, PAs, and health professionals and supports the goals of the <a href="[@]wsma/resources/opioids/better_prescribing_better_treatment/wsma/resources/opioids/better-prescribing-better-treatment.aspx?hkey=b6fb0ec0-8bc2-4e53-bf4c-9f148599cbeb">Better Prescribing, Better Treatment safe-prescribing program</a>.</p> <h3>How to access the podcasts </h3> <p>Access the podcasts via the links in the episode descriptions below, or subscribe to WSMA Podcasts, WSMA's new podcast channel available on <a href="https://podcasts.apple.com/us/podcast/wsma-podcasts/id1702920307">Apple Podcasts</a>, <a href="https://podcasts.google.com/feed/aHR0cHM6Ly93c21hLm9yZy9wb2RjYXN0cy93c21hLnhtbA">Google Podcasts</a>, and <a href="https://open.spotify.com/show/0PBMBLgHr6e0X3OaMjyJON?si=52073329b89c4af1">Spotify</a>.</p> <h3>About episode 9: Opioids and the Bridge Program </h3> <p><a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast/wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?hkey=5d4ff39d-6d34-45da-a94f-d95e682b2863#episode9">In this episode</a>, Dr. Schlicher talks Liz Wolkin, MS, RN, NPD-BC, CEN, program administrator of the Washington State Health Care Authority's emergency department support, clinical quality and care transformation program, about the new state bridge program to support emergency departments and acute care hospitals in the initiation of medications for opioid use disorder and providing best practice care for patients with substance use disorder.</p> <h3>About episode 10: Opioids and Health Equity </h3> <p><a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast/wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?hkey=5d4ff39d-6d34-45da-a94f-d95e682b2863#episode10">In this episode</a>, Dr. Schlicher talks with Rae Wright, MD, an addiction medicine physician in Vancouver, Washington, about what equity in health care looks like, and how addiction and opioid use disorder interface with equity issues (e.g., pain management, the justice system, and access to care).</p> <p>These activities are approved for <em>AMA PRA Category 1 Credit</em><sup>TM</sup>.</p> <h3>Previous episodes </h3> <p>Episode 1: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast/wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?hkey=5d4ff39d-6d34-45da-a94f-d95e682b2863#episode1">The Future of the Better Prescribing, Better Treatment Program at WSMA</a> </p> <p>Episode 2: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast/wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?hkey=5d4ff39d-6d34-45da-a94f-d95e682b2863#episode2">The History of Opioid Prescribing Legislation</a> </p> <p>Episode 3: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast/wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?hkey=5d4ff39d-6d34-45da-a94f-d95e682b2863#episode3">Prescribing Opioids in a Rural Setting</a> </p> <p>Episode 4: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast/wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?hkey=5d4ff39d-6d34-45da-a94f-d95e682b2863#episode4">Opioids in Obstetrics</a> </p> <p>Episode 5: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast/wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?hkey=5d4ff39d-6d34-45da-a94f-d95e682b2863#episode5">Opioids in Pediatrics</a> </p> <p>Episode 6: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx#episode6">Opioids and Hospice</a> </p> <p>Episode 7: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast/wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?hkey=5d4ff39d-6d34-45da-a94f-d95e682b2863#episode7">Opioids in Family Medicine</a> </p> <p>Episode 8: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast/wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?hkey=5d4ff39d-6d34-45da-a94f-d95e682b2863#episode8">Opioids in Cancer-Related Pain</a> </p> </div>10/27/2023 12:00:00 AM1/1/0001 12:00:00 AM
nirsevimab-shortage-interim-guidance-to-protect-infants-from-rsvNirsevimab Shortage - Interim Guidance to Protect Infants from RSVLatest_NewsShared_Content/News/Membership_Memo/2023/october-27/nirsevimab-shortage-interim-guidance-to-protect-infants-from-rsv<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/october/stock-image-2017-doctor-with-toddler-645x425px.jpg" class="pull-right" alt="Doctor with a toddler" /></div> <h5>October 27, 2023</h5> <h2>Nirsevimab Shortage: Interim Guidance to Protect Infants from RSV </h2> <p>Due to high demand and limited supply, state ordering is paused for nirsevimab, the long-acting monoclonal antibody immunization product recommended for preventing respiratory syncytial virus-associated lower respiratory tract disease in infants. The Centers for Disease Control and Prevention has placed additional orders of nirsevimab with the manufacturer and plans to reopen ordering once allocations are in place.</p> <h3>CDC advisory: Options for clinicians to protect infants from RSV </h3> <p>In the context of a <a href="https://www.news.sanofi.us/Sanofi-Beyfortus-Statement">limited supply of nirsevimab</a> during the 2023-2024 RSV season, the CDC recommends prioritizing available nirsevimab 100 mg doses for infants at the highest risk for severe RSV disease: young infants (age <6 months) and infants with underlying conditions that place them at highest risk for severe RSV disease. Recommendations for using 50 mg doses remain unchanged. Avoid using two 50 mg doses for infants weighing ≥5 kilograms (≥11 pounds) to preserve supply of 50 mg doses for infants weighing <5 kilograms (<11 pounds). Physicians and practitioners should be aware that some insurers may not cover the cost of two 50 mg doses for an individual infant.</p> <p>The CDC further recommends that physicians suspend using nirsevimab in <a href="https://publications.aap.org/pediatrics/article/152/1/e2023061803/192153/Palivizumab-Prophylaxis-in-Infants-and-Young?autologincheck=redirected">palivizumab-eligible children</a> aged 8-19 months for the 2023-2024 RSV season. These children should receive palivizumab per <a href="https://publications.aap.org/pediatrics/article/152/1/e2023061803/192153/Palivizumab-Prophylaxis-in-Infants-and-Young?autologincheck=redirected">American Academy of Pediatrics (AAP) recommendations</a>. Nirsevimab should continue to be offered to American Indian and Alaska Native children aged 8-19 months who are not palivizumab-eligible and who live in remote regions, where transporting children with severe RSV for escalation of medical care is more challenging or in communities with known high rates of RSV among older infants and toddlers. Prenatal care providers should discuss potential nirsevimab supply concerns when counseling pregnant people about RSVpreF vaccine (Abrysvo, Pfizer) as maternal vaccination is effective and will reduce the number of infants requiring nirsevimab during the RSV season.</p> <p>For the full health advisory: <a href="https://emergency.cdc.gov/han/2023/pdf/CDC_HAN_499.pdf" target="_blank" rel="noreferrer">Limited Availability of Nirsevimab in the United States-Interim CDC Recommendations to Protect Infants from Respiratory Syncytial Virus during the 2023-2024 Respiratory Virus Season</a>.</p> <h3>Other respiratory illness vaccine updates and resources </h3> <ul> <li>The Food and Drug Administration has <a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDQsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmZkYS5nb3YvbmV3cy1ldmVudHMvcHJlc3MtYW5ub3VuY2VtZW50cy9mZGEtYXV0aG9yaXplcy11cGRhdGVkLW5vdmF2YXgtY292aWQtMTktdmFjY2luZS1mb3JtdWxhdGVkLWJldHRlci1wcm90ZWN0LWFnYWluc3QtY3VycmVudGx5IiwiYnVsbGV0aW5faWQiOiIyMDIzMTAxNy44NDE5NTkzMSJ9.adZL-1S9qFXtBMrZo5ZE7NYINmV4WiiLX3vmgQNTNfc/s/690743948/br/228465103105-l">authorized updated Novavax COVID-19 vaccine</a> to protect against new variants and the original Novavax COVID-19 is no longer authorized. <a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDUsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmZkYS5nb3YvbWVkaWEvMTU5ODk3L2Rvd25sb2FkP2F0dGFjaG1lbnQiLCJidWxsZXRpbl9pZCI6IjIwMjMxMDE3Ljg0MTk1OTMxIn0.Q7USHqAKEsJcSjM__QVqRfl92cs50hNykNlwgHoL8gg/s/690743948/br/228465103105-l">Updated administration guidance</a> is available.</li> <li>The Washington State Department of Health has a new <a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.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.NR3TD1D5g_eU_IOC3JZrRHzjkGePfQkcwSWM3eB2ppk/s/690743948/br/228465103105-l">Respiratory Illness Data Dashboard</a> to track COVID-19, seasonal influenza, and respiratory syncytial virus disease activity by region across the state.</li> <li>Fall 2023 marks the first time that vaccines for those three respiratory illnesses will be available simultaneously. Review the most recent expert consultation from the National Academies' Societal Experts Action Network, <a href="https://nap.nationalacademies.org/read/27261/chapter/1">Promoting Uptake of COVID-19, Influenza, and RSV Vaccines for Fall 2023</a>, which addresses communication strategies and practical strategies for overcoming accessibility challenges to promote uptake of the COVID-19, flu, and RSV vaccines this fall.</li> </ul> <ul> <li>The Department of Health has also updated its popular <a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMTQsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vZG9oLndhLmdvdi9zaXRlcy9kZWZhdWx0L2ZpbGVzLzIwMjItMDcvODI1MDQ3LUNPVklEMTlWYWNjaW5lc1RhYmxlLnBkZiIsImJ1bGxldGluX2lkIjoiMjAyMzEwMTcuODQxOTU5MzEifQ.5mMptVFvvO4iK2qz9hxB6NyX_HpWUBubKOXNHl6vSCI/s/690743948/br/228465103105-l">COVID-19 Vaccine Product Characteristics and Information table</a> to include the 2023-2024 vaccines.</li> </ul> <p>As supply chain constraints have caused delays to the roll out of updated COVID-19 vaccines, some of your patients may have concerns about limited availability. It may help to reassure patients that availability is expected to improve within the next few weeks.</p> <p>Here are some resources to support your patients in locating updated COVID-19 vaccines: </p> <ul> <li><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.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.gQXAvrG6MVOvnfiHxowT6FivojRuYrg6Bu2STAwCFXg/s/690743948/br/228465103105-l">Map</a> of Washington practices, clinics, and other organizations enrolled in the Department of Health's <a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMTYsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vZG9oLndhLmdvdi9wdWJsaWMtaGVhbHRoLWhlYWx0aGNhcmUtcHJvdmlkZXJzL3B1YmxpYy1oZWFsdGgtc3lzdGVtLXJlc291cmNlcy1hbmQtc2VydmljZXMvaW1tdW5pemF0aW9uL2NoaWxkaG9vZC12YWNjaW5lLXByb2dyYW0iLCJidWxsZXRpbl9pZCI6IjIwMjMxMDE3Ljg0MTk1OTMxIn0.1ePk7PH1IlL5ZyLYmI6OhT04kJsJ73HXzY_VYXemp6A/s/690743948/br/228465103105-l">Childhood Vaccine Program</a> and <a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMTcsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vZG9oLndhLmdvdi9wdWJsaWMtaGVhbHRoLWhlYWx0aGNhcmUtcHJvdmlkZXJzL3B1YmxpYy1oZWFsdGgtc3lzdGVtLXJlc291cmNlcy1hbmQtc2VydmljZXMvaW1tdW5pemF0aW9uL2FkdWx0LXZhY2NpbmUtcHJvZ3JhbSIsImJ1bGxldGluX2lkIjoiMjAyMzEwMTcuODQxOTU5MzEifQ.soZbyGybBicHhu6hA8VBlvTbqlREluobBgrBM4-2Rm4/s/690743948/br/228465103105-l">Adult Vaccine Program</a>.</li> <li><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.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.Qd6RBA2tLJxibcqnxAKG1rrvrDT9cVgkA9c4b0UCcTA/s/690743948/br/228465103105-l">Map</a> of Washington Federally Qualified Health Centers.</li> <li><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMTksInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vZG9oLndhLmdvdi95b3UtYW5kLXlvdXItZmFtaWx5L2NhcmUtdmFuLW1vYmlsZS1oZWFsdGgtc2VydmljZXMjZXZlbnQtbGlzdCIsImJ1bGxldGluX2lkIjoiMjAyMzEwMTcuODQxOTU5MzEifQ.NHvcMRUCu4iKooN2jBQOH8WKAyNj3YExyHqjfWUubdM/s/690743948/br/228465103105-l">Care-A-Van</a> Mobile Clinic Locations.</li> </ul> </div>10/27/2023 12:00:00 AM1/1/0001 12:00:00 AM
provide-feedback-in-an-ama-physician-practice-information-surveyProvide Feedback in an AMA Physician Practice Information SurveyLatest_NewsShared_Content/News/Membership_Memo/2023/october-27/provide-feedback-in-an-ama-physician-practice-information-survey<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/october/doctor-piggy-bank-illustration-shutterstock-1860228250-645x425px.png" class="pull-right" alt="Doctor with piggy bank illustration" /></div> <h5>October 27, 2023</h5> <h2>Provide Feedback in an AMA Physician Practice Information Survey </h2> <p>An American Medical Association survey is being distributed to thousands of physician practices and individual physicians across the U.S. The intent of the survey is to collect updated and accurate data on practice costs, which are a key element of physician payment. The survey represents your opportunity to communicate accurate financial and operational information to policymakers, including members of Congress and the Centers for Medicare and Medicaid Services. These data have not been updated since they were last collected over 15 years ago, and it is critically important to update this information to ensure accurate payment.</p> <p>Interested individuals can see <a href="http://wsma.informz.net/z/cjUucD9taT0xMTI4MjgyNSZwPTEmdT0xMTU4MjY5MTYzJmxpPTEwNTA5Nzc5OQ/index.html">here</a> for more information about this survey. <a href="http://wsma.informz.net/z/cjUucD9taT0xMTI4MjgyNSZwPTEmdT0xMTU4MjY5MTYzJmxpPTEwNTA5NzgwMA/index.html">Mathematica</a>, a well-regarded consulting firm, is helping the AMA run this survey. Your practice may receive an email (from <a href="mailto:ppisurvey@mathematica-mpr.com">ppisurvey@mathematica-mpr.com</a>) and a USPS priority mail packet from Mathematica that contains a link to the survey as well as supporting information. Please speak with your practice management colleagues to determine if they have received these communications and ask them to complete this important survey. In the coming weeks or months, your practice, or Mathematica, may also ask you to complete a brief survey on the number of weekly hours spent on direct patient care. We urge you to complete this two-minute survey.</p> </div>10/27/2023 12:00:00 AM1/1/0001 12:00:00 AM
wsma-urges-washingtons-congressional-delegation-to-take-action-to-prevent-medicare-payment-cWSMA Urges Washington's Congressional Delegation to Take Action to Prevent Medicare PaymentLatest_NewsShared_Content/News/Membership_Memo/2023/october-27/wsma-urges-washingtons-congressional-delegation-to-take-action-to-prevent-medicare-payment-c<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/october/medicare-barcode-645px.jpg" class="pull-right" alt="Medicare barcode" /></div> <h5>October 27, 2023</h5> <h2>WSMA Urges Washington's Congressional Delegation to Take Action to Prevent Medicare Payment Cuts </h2> <p>For the third year in a row, physicians face a <a href="https://wsma.org/Shared_Content/News/Membership_Memo/2023/july-28/more-medicare-physician-payment-cuts-on-the-horizon.aspx?_zs=A3aFd1&_zl=VWD89">Medicare payment cut on Jan. 1, 2024</a>. Congress must act immediately to avert the looming 3.36% physician payment cut, which, if allowed to go into effect, would further destabilize physician practices already struggling economically.</p> <p>Congress is no doubt running out of time and has a lot of work to achieve before December's recess, but the WSMA remains committed to bringing attention to this issue by advocating for immediate solutions and long-term reform in the years ahead. The WSMA recently submitted a <a href="javascript://[Uploaded files/News and Publications/newsletters/2023/wsma-letter-medicare-payment-cuts-2024-final.pdf]">comment letter to Washington's congressional delegation</a> requesting immediate action.</p> <p>Averting the pending payment cut is a high priority for the WSMA and the physician community. We will continue monitoring the forthcoming cut as the year comes to an end and keep members apprised of opportunities to engage on the issue.</p> <p>The WSMA also continues to monitor <a href="[@]Shared_Content/News/Membership_Memo/2023/may-12/wsma-urges-washingtons-congressional-delegation-to-support-medicare-payment-reform">broader Medicare reform efforts</a> and looks forward to opportunities to work with congressional offices and partners to improve the Medicare physician fee schedule. For an American Medical Association overview of reform efforts, <a href="https://click.e.ama-assn.org/?qs=2847594f13e1d2e02dc1463dc5fb82b35912a817072a9ea5b7c0db7d323a374e8c76142d2c0f65a30437c9a524231e84fc25de3201b4d53f075848a60b07d9f1bc6925b4aee505c4">register now</a> for "What's next with Medicare payment reform," on Friday, Nov. 3 at 11 a.m. PDT for more on how the AMA, alongside state and national medical specialty societies, is pushing for permanent payment reform and how you can get involved. Speakers include G. Ray Callas, MD, president elect, Texas Medical Association; Katie Orrico, senior vice president, health policy and advocacy, American Association of Neurological Surgeons/Congress of Neurological Surgeons; and Todd Askew, senior vice president, advocacy, American Medical Association.</p> </div>10/27/2023 12:00:00 AM1/1/0001 12:00:00 AM
call_for_comments_on_latest_naturopath_scope_expansion_effortCall for Comments on Latest Naturopath Scope Expansion EffortLatest_NewsShared_Content/News/Membership_Memo/2023/october_13/call_for_comments_on_latest_naturopath_scope_expansion_effort<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2021/February/mortar_pestle-645x425px.jpg" class="pull-right" alt="Naturopaths" /></div> <h5>October 12, 2023</h5> <!-- **************************NEW ARTICLE****************************** --> <h2>Call for Comments on Latest Naturopath Scope Expansion Effort</h2> <p>For the past several years, the naturopathic profession in Washington state has made an effort to <a href="https://wsma.org/wsma/advocacy/legislative_regulatory/regulatory-priorities.aspx">expand naturopaths' scope of practice through legislation and rulemaking</a> without stipulating specific additional education requirements or training. At each juncture, the WSMA has opposed these efforts on the grounds that a naturopath's education and training do not include the comprehensive medical and pharmacological background needed to safely prescribe controlled substances and perform additional procedures.</p> <p>In the latest chapter of this years-long effort, the Washington State Department of Health will be conducting a sunrise review of the naturopathic scope of practice as <a href="https://doh.wa.gov/sites/default/files/2023-10/NaturopathySunriseAppReport2023.pdf?uid=65208b53a2046">requested by the Washington Association of Naturopathic Physicians</a>. The DOH will review <a href="https://app.leg.wa.gov/billsummary?BillNumber=5411&Year=2023&Initiative=false">Senate Bill 5411</a> from last legislative session. As a reminder, SB 5411 makes several updates to the naturopathic practice act including:</p> <ul> <li>Expanding prescriptive authority to include controlled substances schedules II-V. This change would include opioids. Naturopaths currently have a very narrow prescriptive authority that is limited to legend drugs, codeine, testosterone, hormones, and other substances consistent with the practice of naturopathic medicine.</li> <li>Allowing a naturopath to sign and attest to any certification cards, forms, or required documents that a physician can sign.</li> <li>Changing the definition of “minor office procedure” to include primary care services and treatment of minor injuries. This “minor office procedure” has been interpreted by the naturopathic association to include things like in-office abortions.</li> </ul> <p><strong>The WSMA strongly believes that this proposal is a threat to the entire physician community.</strong> Most recently, the naturopathic community has expressed interest in the scopes of practice for obstetrics and gynecology, urology, ophthalmology, dermatology, plastic surgery, and anesthesiology. The applicant report expresses interest in treating behavioral/mental health conditions, performing in-office abortions, and treating opioid use disorder, among other things.</p> <h3>All specialties urged to provide feedback on proposal</h3> <p>As part of its sunrise review and to help DOH make informed recommendations to the Legislature on this proposal, the department is accepting public comments at <a href="mailto:sunrise@doh.wa.gov">sunrise@doh.wa.gov</a> through 5 p.m. on Nov. 20, 2023.<strong> </strong>Given the naturopaths' wide-ranging interest in scope expansion, WSMA staff have routed a call to action to our specialty society partners urging opposition to this proposal. WSMA’s policy team is in the process of reviewing the application, and we will share our draft comment as a model for WSMA members from all specialties to work from.</p> <p>The proposal under review consists of the following documents DOH received from the Legislature and applicant group:</p> <ul> <li><a href="https://doh.wa.gov/sites/default/files/2023-10/NaturopathySunriseRequest2023.pdf?uid=65208b53a13ea">Letter from Senate Health and Long Term Care Committee</a></li> <li><a href="https://doh.wa.gov/sites/default/files/2023-10/SenateBill5411-NP.pdf?uid=65208b53a1ad1">Senate Bill 5411</a></li> <li><a href="https://doh.wa.gov/sites/default/files/2023-10/NaturopathySunriseAppReport2023.pdf?uid=65208b53a2046">Applicant report submitted by WANP</a></li> </ul> <p>Learn more about the DOH <a href="https://doh.wa.gov/about-us/programs-and-services/executive-office-prevention-safety-and-health/health-systems-quality-assurance/sunrise-reviews">sunrise review process</a>. </p> </div>10/20/2023 2:44:47 PM1/1/0001 12:00:00 AM
dea_extends_prescribing_flexibilities_through_end_of_calendar_year_2024DEA Extends Prescribing Flexibilities Through End of Calendar Year 2024Latest_NewsShared_Content/News/Membership_Memo/2023/october_13/dea_extends_prescribing_flexibilities_through_end_of_calendar_year_2024<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img alt="" src="/images/Newsletters/MembershipMemo/2023/october/telemedicine-illustration-645x425px.png" class="pull-right" /></div> <h5>October 12, 2023</h5> <!-- **************************NEW ARTICLE****************************** --> <h2>DEA Extends Prescribing Flexibilities Through End of Calendar Year 2024</h2> <p>The U.S. Drug Enforcement Administration announced an <a href="https://www.federalregister.gov/documents/2023/10/10/2023-22406/second-temporary-extension-of-covid-19-telemedicine-flexibilities-for-prescription-of-controlled">additional temporary rule extension</a> authorizing DEA-registered practitioners to prescribe schedule II-V controlled medications via telemedicine through Dec. 31, 2024, regardless of whether or not the patient and practitioner established a telemedicine relationship on or before Nov. 11, 2023.</p> <p>As the WSMA <a href="https://wsma.org/Shared_Content/News/Membership_Memo/2023/march-24/dea-proposes-extending-telemedicine-flexibilities-for-prescribing-controlled-substances.aspx?_zs=A3aFd1&_zl=ToAt8">previously </a> <a href="https://wsma.org/Shared_Content/News/Membership_Memo/2023/april-14/wsma-provides-feedback-on-dea-rulemaking-extending-telemedicine-flexibilities?_zs=A3aFd1&_zl=5fJv8">reported</a>, the DEA proposed rulemaking earlier this year to expand telemedicine flexibilities adopted during the COVID-19 public health emergency. The <a href="http://www.wsma.org/Shared_Content/News/Membership_Memo/2023/march-24/dea-proposes-extending-telemedicine-flexibilities-for-prescribing-controlled-substances.aspx?_zs=A3aFd1&_zl=ToAt8">proposed rules</a>, intended to provide safeguards for a narrow subset of telemedicine and audio-only consultations that result in the prescribing of a controlled substance, including buprenorphine for treatment of opioid use disorder, were widely criticized by the medical community for their restrictions on access to needed treatments. The WSMA, in collaboration with the American Medical Association, submitted comment letters outlining various concerns with the rules and requested that the DEA amend the proposed rules to avoid a lapse in patient care, promote patient safety, and avoid nonoptimal treatment options.</p> <p>The latest extension comes as the DEA continues to review permanent policy changes and plans to promulgate a final set of telemedicine regulations by the fall of 2024. The federal agency says the additional time will allow patients and practitioners to plan for, and adapt to, the new rules once they are issued.</p> </div>10/12/2023 3:54:37 PM1/1/0001 12:00:00 AM
mukilteo-ob-gyn-named-president-of-wsmaMukilteo OB-GYN Named President of WSMALatest_NewsShared_Content/News/Press_Release/2023/mukilteo-ob-gyn-named-president-of-wsma<div class="col-md-12"> <div class="col-sm-5 pull-right"><img src="/images/Logos/Press-Release-Graphic-2019-Branding.png" class="pull-right" alt="WSMA press release logo" /></div> <h5>Sept. 25, 2023</h5> <h2>Mukilteo OB-GYN Named President of WSMA</h2> <p> SEATTLE - Mukilteo obstetrician-gynecologist Nariman Heshmati, MD, MBA, FACOG, was named president of the Washington State Medical Association at its annual House of Delegates meeting on Sunday, Sept. 24. The WSMA represents nearly 13,000 physicians, physician assistants, resident physicians, and medical students throughout Washington state. </p> <p> Dr. Heshmati is the executive medical director of affordability, advocacy, and pharmacy for Optum Washington, which includes The Everett Clinic, The Polyclinic, and The Optum Care Network Pacific Northwest. In his role at Optum Washington, Dr. Heshmati has accountability for total cost of care, external relationships, and pharmacy services. </p> <p> Born in Iran to a family of clinicians-his father an orthopedic surgeon and his mother a psychologist-a young Dr. Heshmati and his family fled their home country during the Iranian Revolution, eventually emigrating to the United States and settling in Satellite Beach, Florida. Reestablishing medical careers in their new country, Dr. Heshmati's father and mother became role models for their children, inspiring them to pursue careers in medicine, with Dr. Heshmati's brother also becoming a physician and his sister a psychologist. </p> <p> Dr. Heshmati received his undergraduate degree in 2001 at the University of Florida in Gainesville, followed by a medical doctorate in 2005 from Florida State University in Tallahassee where he served as class president and founded the medical school college council. He completed a residency in obstetrics and gynecology in 2009 at Vanderbilt University in Nashville, Tennessee, during which time he was a contributor to the 5th edition textbook of Blueprints in Obstetrics & Gynecology. Dr. Heshmati recently received an MBA from Seattle University. </p> <p> Dr. Heshmati moved to Mukilteo, Washington, in 2009 with his wife Kathryne to join The Everett Clinic, where they continue to live with their two children, Robert and Sirena. Dr. Heshmati has served Everett and the surrounding Snohomish County communities as a practicing OB-GYN for more than 14 years and has pursued executive and leadership roles in local clinics and health systems. At Providence Regional Medical Center in Everett, he served as chief of women's and children's services and medical director of obstetrics. At The Everett Clinic, he has served on the clinical leadership board, as a senior regional medical director, as medical director of advocacy, and as associate medical director of surgical services, among other roles. </p> <p> Demonstrating a steadfast commitment to his community and to organized medicine, Dr. Heshmati has served on the Washington Health Alliance Low Back Pain Implementation Collaborative, was appointed by Gov. Jay Inslee to the Washington Pandemic After Action Review Task Force, and is on the March of Dimes Washington State board of directors. He is the Washington section legislative chair for the American College of Obstetricians and Gynecologists. Along with his membership in the WSMA and the national and state chapters of his specialty society, he is a member of the American Medical Association. In addition to his executive leadership at the WSMA, Dr. Heshmati serves as a WSMA delegate to the AMA and is past board chair of WSMA's political action committee, WAMPAC. </p> <p> Dr. Heshmati is widely published, has presented at numerous national conferences including AMGA (formerly American Medical Group Association), Becker's Hospital Review, America's Physician Groups, and State of Reform, and has received a number of awards, including Seattle Met Magazine "Top Doc." He is the host of a popular YouTube channel, "DrNari," featuring women's health informational videos and is active on X, formerly known as Twitter, under the handle "@nariheshmati." </p> <p> The following physicians were also elected as officers at the meeting: John Bramhall, MD, PhD, Seattle anesthesiologist, president-elect; Bridget Bush, MD, FASA, Anacortes anesthesiologist, vice president; and Matt Hollon, MD, MPH, FACP, Spokane internist, secretary-treasurer. The fifth officer of WSMA's executive committee is Past President Katina Rue, DO, FAAFP, FACOFP, Yakima family physician, who will serve as committee chair. </p> <p> WSMA members newly elected to the association’s board of trustees include Rajneet Lamba, MD, Kirkland internist; Amy Ellingson, MD, Brewster family physician; Lisa Ivanjack, MD, Bothell internist; John Scott, MD, Seattle gastroenterologist; Peter Barkett, MD, Silverdale internist; and Andy Shang, medical student, Pacific Northwest University of Health Sciences. For more information, see this <a href="https://wsma.org/wsma/about_us/leadership/board_of_trustees/wsma/about/leadership/board_of_trustees/board_of_trustees.aspx?hkey=0abc484b-c165-4fb1-90b5-1f72370b18d2">full roster of WSMA board of trustees members</a>. </p> <p> <a href="javascript://[Uploaded files/News and Publications/Press Room/nariman-heshmati-md-wsma.jpg]">Download a high-resolution portrait of WSMA President Nariman Heshmati, MD, FACOG</a>. </p> <p> For more information, contact: </p> <p> Graham Short<br /> WSMA Director of Communications<br /> 206.329.6851 (cell/text)<br /> <a href="mailto:gfs@wsma.org">gfs@wsma.org</a> </p> <p><strong>About the WSMA</strong><br /> The Washington State Medical Association represents nearly 13,000 physicians, physician assistants, resident physicians, and medical students across all specialties and practice types in Washington state. The WSMA has advocated on behalf of the house of medicine for more than 125 years. Our vision is to make Washington state the best place to practice medicine and receive care. </p> </div>9/25/2023 12:00:00 AM1/1/0001 12:00:00 AM
wsma-joins-wsam-in-requesting-bree-collaborative-review-of-oud-treatment-practicesWSMA Joins WSAM in Requesting Bree Collaborative Review of OUD Treatment PracticesLatest_NewsShared_Content/News/Membership_Memo/2023/september-22/wsma-joins-wsam-in-requesting-bree-collaborative-review-of-oud-treatment-practices<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/september/buprenorphine-butrans10mcg-645px.jpg" class="pull-right" alt="Packets of Butrans" /></div> <h5>September 22, 2023</h5> <!-- **************************NEW ARTICLE****************************** --> <h2>WSMA Joins WSAM in Requesting Bree Collaborative Review of OUD Treatment Practices</h2> <p>Each year, the Dr. Robert Bree Collaborative identifies and selects health care services to review that either have high variation in the way care is delivered, are frequently used but do not lead to better care or patient health, or that have patient safety issues. Once topics are formally selected, the Bree Collaborative forms expert work groups to review existing data and current policies, regulations, and practices to develop related recommendations for the Washington State Health Care Authority to guide the type of health care provided to Medicaid enrollees, state employees, and other groups.</p> <p>Topic proposals from interested stakeholders were due July 2023. Citing existing WSMA policy, the Washington Society of Addiction Medicine formally requested WSMA's leadership to extend its support of WSAM's proposals on eliminating buprenorphine dose limits and expanding access to medication for opioid use disorder in residential treatment facilities. In advance of the Bree Collaborative finalizing 2024 topics, the WSMA submitted <a href="javascript://[Uploaded files/News and Publications/newsletters/2023/wsma-letter-of-support-wsam-2024-topic-proposals.pdf]">a letter of support of WSAM's proposals</a>, noting the state's need to improve health care delivery and outcomes for individuals impacted by opioid use disorder, especially as overdoses in Washington state have <a href="https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm">increased 31%</a> between April 2022 and April 2023.</p> <p>The WSMA is monitoring the Bree Collaborative's discussions on 2024 proposals and will report out on final topics once they are selected.</p> </div>9/22/2023 12:00:00 AM1/1/0001 12:00:00 AM
weekly-rounds-september-15-2023-on-the-state-of-physician-well-beingWeekly Rounds: September 15, 2023 - On the State of Physician Well-BeingLatest_NewsShared_Content/News/Weekly_Rounds/2023/weekly-rounds-september-15-2023-on-the-state-of-physician-well-being<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Weekly%20Rounds/Weekly-Rounds-Article-Graphic-2022-645x425px.png" class="pull-right" alt="Weekly Rounds logo" /></div> <h5>Sept. 15, 2023</h5> <h2> On the State of Physician Well-Being </h2> <p>Jennifer Hanscom, CEO</p> <p> In anticipation of <a href="https://npsaday.org/">National Physician Suicide Awareness Day</a> this Sunday, The Physicians Foundation has announced findings from its annual survey on the state of physician well-being. Surprising to no one within health care, the findings paint a picture of low physician morale and well-being. Additionally, the survey breaks out young physicians and physicians in training for the first time, and notes that residents and medical students are also plagued by the effects of burnout and suicide. </p> <p> Key survey findings include: </p> <ul> <li>Medical students' overall well-being is lower than both residents and physicians. <ul> <li>More than six in 10 residents (61%) and seven in 10 students (71%) report experiencing feelings of burnout.</li> <li>Though just starting their careers, a shocking proportion of students (45%) know a colleague or peer who has considered suicide, compared to residents (38%) and physicians (36%).</li> </ul> </li> </ul> <ul> <li>Current and future physicians alike report stigma and structural barriers negatively affect their overall well-being and mental health. <ul> <li>Nearly eight in 10 physicians (78%), residents (79%), and medical students (76%) agree that there is stigma surrounding mental health and seeking mental health care among physicians.</li> <li>Nearly five in 10 residents and medical students were either afraid or knew another colleague fearful of seeking mental health care given questions asked in medical licensure/credentialing/insurance applications.</li> </ul> </li> </ul> <p> Find the full survey findings from the 2023 Survey of America's Current and Future Physicians on <a href="https://physiciansfoundation.org/research/amplifying-physician-resident-and-student-voices-to-drive-wellbeing-and-care-delivery-solutions/">The Physicians Foundation website</a>. </p> <p> Physician and clinician burnout and related resignations and early retirements continue to pose a major threat to a health care industry that remains in need of clinical leaders, physicians, and other front-line staff to ensure capacity. </p> <p> The issue has been in the forefront of industry news for years, with the pandemic bringing it firmly into the national spotlight: In May 2022, U.S. Surgeon General Dr. Vivek Murthy issued an <a href="https://www.hhs.gov/sites/default/files/health-worker-wellbeing-advisory.pdf" target="_blank" rel="noreferrer">advisory highlighting the urgent need to address the health worker burnout crisis across the country</a>, pointing to the record numbers of health workers who are quitting or reporting that they intend to quit. </p> <p> The future of medicine is dependent on change to offer the right resources and eliminate barriers that impact physicians' well-being. The solutions to improve physician well-being and prevent suicide are not a secret-physicians, residents, and medical students have identified the solutions they need. At the top of the list, physicians (80%) and residents (85%) agree that reducing administrative burdens, such as low-value work, insurance approvals, and unnecessary mandatory training, is helpful to improving well-being. </p> <p> The health worker burnout and workforce retention crisis, if not addressed, will make it harder for patients to get care when they need it, cause health costs to rise, hinder our ability to prepare for the next public health emergency, and worsen health disparities. </p> <p> To that end, the WSMA has convened a small work group with members from the Washington State Medical Group Management Association and several large group leaders to create a package of workforce policy solutions in advance of the 2024 legislative session. This workforce work group is putting the finishing touches on its draft recommendations, which will go before WSMA leadership this month. Look for a wider release of these recommendations later this year. </p> <p> In addition, the WSMA Foundation has been awarded a grant from The Physicians Foundation for a physician wellness initiative that will look at systemic solutions to physician and physician assistant burnout, including convening health systems and large groups to develop best practices and to pledge their commitment to meet those best practices. We are seeking physician and PA members to join a new committee to help lead this work, with compensation available for your time and commitment. To learn more about the expectations of service on the committee, reach out to WSMA Associate Director of Quality and Leadership Programs <a href="monica@wsma.org">Monica Salgaonkar</a>. </p> <p> For this Sunday's day of awareness around physician suicide, I hope you'll join me in doing what you can to raise the visibility of the issue. Find social media and other materials in the <a href="https://npsaday.org/toolkit/">Toolkit</a> section on the <a href="https://npsaday.org/">NPSA Day website</a>. </p> </div>9/15/2023 12:00:00 AM1/1/0001 12:00:00 AM
a_family_traditionA Family TraditionLatest_NewsShared_Content/News/Latest_News/2023/a_family_tradition<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/september-october/sept-oct-2023-reports-cover-645x425px.jpeg" class="pull-right" alt="cover of September/October 2023 issue of WSMA Reports" /></div> <h5>Sept. 14, 2023</h5> <h2>A Family Tradition</h2> <p>By Milana McLead</p> <p> Nariman Heshmati, MD, is a problem solver; the more difficult the issue, the better it suits him. Whether it's automating his house so the lights are motion activated, programming the fireplace to function with a remote, operating on a patient in a life- threatening situation, or perhaps even more daunting, fixing what's broken in health care, he's up for the challenge. </p> <p> "We are designing a system that we will all need," he says. "Our patients want us to ensure that the health care system we have for them is the same one we want to be in, one that we would get care in ourselves. We've got the ability to design that system." </p> <p> His passion for doing just that is more than a mantra, it's personal. His efforts to that end literally made a difference to his own family's life. "My kids were born at Providence, where I was division chief for women's and children's services at the time," he says. It was then the second- busiest labor and delivery unit in the state. As division chief and an OB-GYN, Dr. Heshmati and his team worked to improve the neonatal intensive care unit, striving for process and quality improvements. </p> <p> "When my wife came in [for delivery], I knew it was too early," he says. As their newborn son, Robert, spent his first 10 days in the NICU, Dr. Heshmati understandably wanted him to have the best care and the best chance of surviving. "Then the irony hit me: All those things I'd worked on, that my team worked on ... my family was actually experiencing the result of those efforts," he says. "To me, it's not just a job. We are developing a system not only to take care of patients, but to take care of ourselves and our families." </p> <div class="col-sm-12" style="text-align: center;"> <blockquote style="text-align: center;"><strong> <em><span style="font-size: 18px;"> Our patients want us to ensure that the health care system we have for them is the same one we want to be in, one that we would get care in ourselves. We’ve got the ability to design that system</span>.</em></strong> </blockquote> </div> <p> Working to fix that system also drives his involvement in the WSMA, advocacy, and organized medicine. During his earliest days in medical school at Florida State University, getting involved was heavily encouraged. He served on the political action committee of the Florida Medical Association, even spending a month embedded with the association's lobbying team at the Capitol in Tallahassee at the height of Florida's medical malpractice reform. The "sea of white coats on the steps of the Capitol demanding action" launched him into advocacy efforts that continue today. </p> <p> "One of the hardest challenges being a physician is that we are in such a regulated industry, it's easy to feel that you lose autonomy and control. The system around you is deciding how you can provide care and all you want to do is provide that care," he says. "Being involved in the WSMA gave me visibility to how decisions are made, how to improve the system, and how to give voice to the physician perspective. </p> <p> "When you're part of the WSMA, instead of feeling like the health care system is crumbling and patients can't get the care they need, you can feel like you're in the driver's seat to speak up to say, 'This system is not OK, and here is what we need to take care of the community.' " </p> <div class="col-sm-5 pull-right newsbody" style="text-align: center;"> <p><img alt="Dr. Heshmati" src="/images/Newsletters/Reports/2023/september-october/Nariman_Heshmati_0051_425x650.jpg " class="pull-right" width="425" height="650" /></p> </div> <p> Taking care of the community is a thread that's woven into most, if not all, of what Dr. Heshmati thinks about in terms of leadership, advocacy, and impact. While he's done the clinical 80-hour week, been on call around the clock, developed departments, argued legislation, and testified in front of elected officials, he is now focused on where he can make the greatest impact: physician leadership. "In my leadership roles, I might be able to help 10 people, or 100 people, or maybe 1,000 people. That ability to make a broader impact is what drives me," he says. "I feel strongly that medical organizations need physician leaders. To take care of patients, we need to have the right ingredients, the right rules, the right system around us. If we're not at the table helping guide that process, that's when we see regulations we don't need, policies that don't make sense, and interference in the patient-physician relationship." </p> <p> Early in his life, he saw firsthand the value and importance of the patient- physician relationship. As a child, he watched his parents taking care of patients. It was practically destiny that Dr. Heshmati would become a physician, considering that his father, two uncles, and older brother are physicians, and his mother and older sister are psychologists. Growing up near Florida's Cape Canaveral, instead of dreaming about space adventures, he hung out at his parents' primary care medical offices while they worked. "While my dad was seeing patients, my mom ran the office," he says, "and I was there too, playing with toys." </p> <p> That childhood may sound idyllic, but his family's journey to that point was anything but. Dr. Heshmati was born in Iran on New Year's Day 1980. As he entered the world, revolution had upended his country; it was day 59 of the seizure of the American Embassy in Tehran and the Iran-Iraq war was raging. His father was an orthopedic surgeon and head of surgery at the major army hospital in Tehran, so though his work was deemed necessary, it wasn't necessarily safe for him or his family to remain in Iran. After months of covert planning, the elder Dr. Heshmati and family left everything behind, fleeing their homeland, first to Europe and ultimately to Florida's Satellite Beach. </p> <p> His father reestablished his credentials and served the community in primary care, then as Brevard County's public health director, and ultimately as a revered public health advocate: When he retired, the building he worked in was renamed in his honor. He was widely known for innovative programs he created to ensure access to care, maternity care, vaccines, and more. </p> <p> "My dad was a huge influence," Dr. Heshmati says. His father modeled, well before it was popular, that everyone should have access to health care. "Everyone knew my dad and would tell me 'My child was sick and was able to use this program [your dad created].' That had an impact on me. I realized if I go into medicine, the positive impact I can make on a community can be significant." </p> <p> His parents shaped and inspired his life, from making a positive impact in everything you do ("keep your community healthy") to having a strong work ethic ("work hard to get results"). Their journey of leaving everything behind and rebuilding-new land, new language- also inspired a sense of optimism for the younger Dr. Heshmati. "They had a sense of no matter what the challenge is, we have the ability to get things done here," he says. </p> <p> As incoming president of the WSMA, he's optimistic about getting things done, together. "What speaks to me is the power we have when our voices are unified," he says. "When we come together, we have significant power to implement change. Some of the brightest and most dedicated people I've ever seen are in health care. If you had to pick a team to improve health care, this is the team. Our members are that team. We can make this the best place to practice medicine and receive care." </p> <p> <em>Milana McLead is WSMA's senior director of strategic communications and membership.</em> </p> <h3>Snapshot </h3> <p><strong>Family:</strong> Met his wife, Kathryne, during his undergraduate studies at the University of Florida. Their son, Robert, is 10; their daughter, Sirena, is 7.</p> <p><strong>First language: </strong>Farsi. He still understands it but must work at speaking it. </p> <p><strong>Day job:</strong> Senior regional medical director for surgery and specialty for Optum’s Washington market. Oversees more than 40 departments and multiple ambulatory surgical centers between The Polyclinic and The Everett Clinic and has accountability for more than $400 million in revenue. </p> <p><strong>Office décor</strong>: Drawings by his kids: “I love having these reminders of my family in my office. Why do we do what we do? It’s for our kids.” </p> <p><strong>Social media:</strong> Includes his “DrNari” YouTube channel and an endless stream of selfies on Twitter. “The first thing patients do when they have concerns is go to Google. Better to put the right information out there because they’re going to look there anyway.”</p> <p> <strong>Starting the day: </strong>A 4 a.m. wake-up alarm, a work out, then a 10-mile e-bike ride to his office in a nondescript, highly secure building in Everett. “Every day we have an opportunity to make an impact. When I wake up, I look forward to that.” </p> <p><strong>Favorite quote:</strong> “Coming together is a beginning, staying together is progress, working together is success.”</p> <p> <em>This article was featured in the September/October 2023 issue of WSMA Reports, WSMA's print magazine.</em> </p> </div>9/14/2023 12:00:00 AM1/1/0001 12:00:00 AM
doctors-making-a-difference-sara-mazzoni-mdDoctors Making a Difference: Sara Mazzoni, MDLatest_NewsShared_Content/News/Latest_News/2023/doctors-making-a-difference-sara-mazzoni-md<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/september-october/dmd-mazzoni-website-image-645x425px.png" class="pull-right" alt="Doctors Making a Difference logo: Sara Mazzoni, MD" /></div> <h5>Sept. 14, 2023</h5> <h2>Doctors Making a Difference: Sara Mazzoni, MD</h2> <p> For Sara Mazzoni, MD, MPH, division chief of OB-GYN at Harborview Medical Center in Seattle, quality maternal health care goes hand in hand with the professional well-being of the physicians providing it. At the OB-GYN clinic at Harborview, she's focusing on both fighting burnout among physicians and the issues that can lead to inequitable care for patients often left behind in health care. She talked with WSMA Reports about the landscape of maternal and reproductive care. </p> <p> <strong><em>WSMA Reports:</em> What are the most challenging issues in maternal care and reproductive care right now?</strong> </p> <p> <em>Dr. Mazzoni:</em> The issues at the top of my mind are the attacks on reproductive health care inclusive of the Dobbs [v. Jackson Women's Health Care] decision and its aftermath, our nation's abysmal maternal mortality rate, and the disparities in all reproductive health outcomes. </p> <p> <strong>As a medical director at Harborview, are there aspects of improving maternal and reproductive care that you're focusing on? </strong> </p> <p> I'm constantly focused on two things: centering our most marginalized patients and improving the well-being of our physicians and clinicians. At Harborview, we care for the full spectrum of our community. If we can focus on the patient experience and outcomes of our most underserved patients, then all patients will benefit. We are continuously striving to improve our delivery of equitable and inclusive care for all patients, but especially those often left behind in our health care system. </p> <p> With the second issue, our group of physicians and clinicians are all women. We know following the pandemic that female physicians are facing a level of burnout higher than their male peers. Every day I do what I can to fight burnout and increase professional satisfaction for our physicians, knowing that if they have improved well-being, our patients will have better outcomes. </p> <p> <strong>What are the biggest factors you see in your practice that influence maternal and reproductive health outside of the care they receive in clinic, such as social factors?</strong> </p> <p> So many! Prenatal care is such a small piece of a pregnant person's experience, and often doesn't have a huge impact on overall maternal health. The places we live, work, and play impact our health to a large degree, and this is no different for reproductive health. Stress plays a role in pregnancy in a way we don't yet understand. Social factors that increase a person's stress, such as unstable housing and food insecurity, clearly impact maternal health in a way greater than medical care. </p> <p> <strong>Are there things that physicians and physician assistants from other specialties can do to support good maternal and reproductive care for patients?</strong> </p> <p> Other clinicians can put contraception on their radar. We frequently see people who are interacting with the health care system due to serious health problems who then have an unintended pregnancy. If a physician is treating a reproductive- aged person for poorly controlled diabetes, for example, add contraception to the checklist! </p> <p> <strong>What system-level changes in the greater health care ecosystem need to be made to ensure all women and pregnant people receive the highest-quality care? </strong> </p> <p> There are seismic changes needed in the entire system for all people to receive highest-quality care. Following the pandemic, it is abundantly clear the system is broken. Clinicians are burned out and disillusioned. Patients don't trust the system. We are largely functioning in an insurance system rather than a health care system. These are overarching issues, however, and don't answer the question. </p> <p> Administrative bloat in the entire system needs to be addressed; there are layers upon layers of administrators, all of whom may not be improving the quality of care. The administrative burden on clinicians needs to be decreased so that we can spend more time focused on patient care and less drowning in the electronic medical record. We need more mental health professionals and social workers trained and integrated into all aspects of health care. Finally, we need to address systemic racism throughout our health care system so that Black women aren't terrified to give birth in our hospitals and all people have equitable health outcomes. </p> <p> <em><em>This article was featured in the September/October 2023 issue of WSMA Reports, WSMA's print magazine.</em></em> </p> </div>9/14/2023 12:00:00 AM1/1/0001 12:00:00 AM
ama-to-host-webinar-on-making-care-primary-model-sept-27AMA to Host Webinar on Making Care Primary Model Sept. 27Latest_NewsShared_Content/News/Membership_Memo/2023/september-7/ama-to-host-webinar-on-making-care-primary-model-sept-27<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/september/maxresdefault.jpg" class="pull-right" alt="Making Care Primary Model diagram" /></div> <h5>September 8, 2023</h5> <h2>AMA to Host Webinar on Making Care Primary Model Sept. 27</h2> <p>Earlier this summer, the Centers for Medicare and Medicaid Services announced a new, voluntary 10.5-year primary care model intended to improve care management and care coordination, foster partnerships between primary care and specialists, and leverage community resources to address patients' health and social needs. CMS is testing this "Making Care Primary" model in eight states, including Washington state, and recently released its <a href="https://www.cms.gov/files/document/mcp-rfa.pdf" target="_blank" rel="noreferrer">request for applications</a>, which serves as an introduction to the model for prospective applicants. The Making Care Primary application went live this week and will close on Nov. 30. Participants will be selected for the model in early 2024 and onboarding will take place between April-July 2024.</p> <p>In preparation for applications to go live, the American Medical Association is collaborating with American College of Physicians and American Academy of Family Physicians to host an informative webinar where physicians and physician assistants interested in applying can hear directly from CMS staff. Additional details, including registration link, are forthcoming. For the time being, interested individuals are encouraged to mark their calendar for Wednesday, Sept. 27, 4-5 p.m. PT. Reach out to <a href="mailto:Suzanne.Joy@ama-assn.org">Suzanne.Joy@ama-assn.org</a> with questions. Otherwise, stay tuned for more information.</p> </div>9/8/2023 12:00:00 AM1/1/0001 12:00:00 AM
ukrainian-newcomer-continuing-education-now-availableUkrainian Newcomer Continuing Education Now AvailableLatest_NewsShared_Content/News/Membership_Memo/2023/september-7/ukrainian-newcomer-continuing-education-now-available<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/september/ukrainian-flag-645x425px.jpeg" class="pull-right" alt="Ukrainian flag" /></div> <h5>September 8, 2023</h5> <h2>Ukrainian Newcomer Continuing Education Now Available</h2> <p>The Washington State Department of Health has created a training specifically designed to help health care professionals who work with Ukrainian new arrivals, titled <a href="https://immunitycommunitywa.org/courses/new-connecting-with-ukrainian-refugees-meeting-their-needs-with-better-care-and-key-services/">"Connecting with Ukrainian refugees: Meeting their needs with better care and key services."</a> This course, informed during development by input from WSMA members, is free and will confer continuing education credits for nurses, physicians, pharmacists, and medical assistants.</p> <p>The training hopes to empower anybody working with newly arrived Ukrainians with tools and resources to</p> <ul> <li>Help build positive relationships</li> <li>Conduct screenings for physical and mental health needs</li> <li>Provide information about available benefits and services</li> <li>And more.</li> </ul> <p>For those working with Ukrainian newcomers, this training is important because it highlights the needs specific to this population and provides crucial background information for practitioners to consider as they form treatment plans and engage in conversations with their patients and clients.</p> <p><a href="https://immunitycommunitywa.org/courses/new-connecting-with-ukrainian-refugees-meeting-their-needs-with-better-care-and-key-services/">We invite you to take the training yourself and share with anyone interested</a>. The DOH offers a big thank you to the WSMA members who pilot tested this training and ensured it met the needs of Washington physicians and health care professionals.</p> </div>9/8/2023 12:00:00 AM1/1/0001 12:00:00 AM
update-on-implementation-of-balance-billing-lawsUpdate on Implementation of Balance Billing LawsLatest_NewsShared_Content/News/Membership_Memo/2023/september-7/update-on-implementation-of-balance-billing-laws<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/september/invoice_645x425.jpg" class="pull-right" alt="Calculator, stethoscope, bill, pen" /></div> <h5>September 8, 2023</h5> <!-- **************************NEW ARTICLE****************************** --> <h2>Update on Implementation of Balance Billing Laws</h2> <p>Your WSMA has engaged extensively in recent years on state and federal legislation relating to balance billing, seeking to ensure fair reimbursement and associated policies in circumstances where physicians provide care to enrollees of health plans they are not contracted with. With the passage of a state law, the Balance Billing Protection Act, in 2019 and a federal law, the No Surprises Act, in 2020, our attention has turned to how the two laws are implemented. WSMA members should be aware of recent important updates on both laws.</p> <p>At the state level, disputes on appropriate reimbursement are governed by an arbitration process under the Balance Billing Protection Act. The state arbitration system was slated to be decommissioned on July 1, with dispute resolution migrating to the federal independent dispute resolution system under the No Surprises Act. Due to WSMA advocacy, the state's Office of the Insurance Commissioner <a href="https://www.insurance.wa.gov/arbitration-and-using-balance-billing-data-set?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=">recently announced</a> that the state arbitration system will remain in place at least until July 1, 2024. This is a positive development as state arbitration has produced favorable results for physicians, in terms of payment determinations as well as maintaining incentives for insurance carriers to contract.</p> <p>By contrast to the experience of the state arbitration system, the implementation of federal independent dispute resolution system has been disastrous. Federal regulators repeatedly went beyond the bounds of the law passed by Congress to skew the dispute resolution process towards insurance carriers. The Texas Medical Association has brought <em>four</em> successful lawsuits challenging the implementation of the dispute resolution process (the fourth favorable <a href="https://www.fiercehealthcare.com/providers/texas-docs-fourth-courtroom-win-over-hhs-interrupts-out-network-billing-arbitration-yet">ruling issued just last week</a>), and as a response, <a href="https://www.cms.gov/NOSURPRISES">federal regulators have paused the implementation of the dispute resolution system</a> "until the departments can provide additional instructions." </p> <p>For questions, contact WSMA Director of Government Affairs Sean Graham at <a href="mailto:sean@wsma.org">sean@wsma.org</a>.</p> </div>9/8/2023 12:00:00 AM1/1/0001 12:00:00 AM
 
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